title: Safety of intraoperative electrophysiological monitoring (TES and EMG) for spinal and cranial lesions.
abstract: Intraoperative motor evoked potentials (MEP) and electromyography (EMG) monitoring in patients with spinal and cranial lesions is a valuable tool for prevention of postoperative motor deficits. The purpose of this study was to determine whether electrophysiological monitoring during skull base, spinal cord, and spinal surgery might be useful for predicting postoperative motor deterioration. From January 2012 to March 2013, thirty-three consecutive patients were studied using intraoperative monitoring (Nuvasive NV-M5 System) to check the integrity of brainstem, spinal cord, and nerve roots, recording transcranial motor evoked potentials (TcMEPs) and electromyography. Changes in MEPs and EMGs were related to postoperative deficits. Preoperative diagnosis included skull base and brainstem lesions (6 patients), spinal tumors (11 patients), spinal deformity (16 cases). Using TcMEPs and EMG is a practicable and safe method. MEPs are useful in any surgery in which the brainstem and spinal cord are at risk. EMG stimulation helps to identify an optimal trans-psoas entry point for an extreme lateral lumbar interbody fusion (XLIF) approach to protect against potential nerve injury. This neural navigation technique via a surgeon-interpreted interface assists the surgical team in safely removing lesions and accessing the intervertebral disc space for minimally invasive spinal procedures.
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gazzeri
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Faiola
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Neroni
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiore
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Callovini
authors.affiliation: Department of Neurosurgery San Giovanni Addolorata Hospital Rome, Italy.
authors.forename: Mauro
authors.initials: M
authors.lastname: Pischedda
authors.affiliation: Department of Neurosurgery University Hospital Virgen de la Arrixaca Murcia, Spain.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Galarza
mesh_terms: D000328:Adult; D000368:Aged; D001930:Brain Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D004569:Electroencephalography / Q000379:methods*; D004576:Electromyography / Q000379:methods*; D005260:Female; D006801:Humans; D064795:Intraoperative Neurophysiological Monitoring / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*; D019635:Neurosurgical Procedures / Q000009:adverse effects* / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control*